Knee Osteoarthritis Guideline
Knee pain is most often a manifestation of knee osteoarthrosis. This disease affects millions of people around the world. But an endoprosthesis is not always required. There are new effective methods of treating degenerative processes of the swollen knee joint that eliminate both the causes and symptoms. The most important thing for each patient is to know the causes and symptoms of the disease and the options for its treatment.
Who is affected by osteoarthritis?
Degenerative joint disease is the most common type of intraarticular inflammation. Despite the fact that the disease can occur even among young people, the risk increases in people over 45. Numerous studies show that osteoarthritis of the knees (swollen knees) is one of the most common. Research also shows that women are more prone to arthrosis.
The most common cause of knee osteoarthrosis is age. Almost every person at a certain age has degenerative changes. However, there are a number of factors that increase the risk of significant osteoarthrosis, even at a younger age:
- age – the ability of cartilage tissue to regenerate decreases with age. At the same time, the number of joint rounds increases, micro-loads, and sometimes severe injuries, are accumulated.
- overweight – increases the load on the knee joint. Each extra kilo loads the knees for another 3-4 kg. Pathological adipose tissue produces substances that enter the joint through the bloodstream and cause damage.
- atherosclerosis (poor blood supply to the subchondral bone, bone infarction).
- hormonal disorders – a decrease in body weight of 5 kg can reduce pain even by 50%.
- hereditary factor. Genetic factors play an important role in the development of osteoarthrosis. The occurrence of arthrosis or rheumatic disease in parents significantly increases the risk of disease in the patient. The wrong axis of the limb can also be inherited, causing an overload of a given knee compartment and the development of degenerative changes. This occurs in the case of valgus or varus knee deformity.
- gender – women over 55 are more likely to get sick than men of the same age. Hormonal factors influence.
- injuries and overloads. As a rule, injuries depend on the type of person’s activities. People are more likely to develop degenerative changes due to frequent and incorrect loads and pressure on the articular surfaces.
- sports. Professional athletes such as football, tennis, basketball or sprint, are burdened with an increased risk of developing osteoarthritis of the knee joint. A large group of people practices recreational sports. Among them, runners have the most problems with their knees (they have swollen knees’ pain). This means that athletes must use all precautions to avoid injury and overload. It is important to do regular and moderate exercises and stretching. In fact, it is the weak muscles surrounding the knee that reduce its stability and result in faster “abrasion” of the cartilage and degenerative changes.
Other causes include people suffering from rheumatoid arthritis, which is the second most common type of joint inflammation. In these patients, the correct treatment of the underlying disease is necessary. In addition, people with certain metabolic disorders (for example, as a result of excess iron or growth hormone) or connective tissue (for example, constitutional hypermobility of the joints) increase the risk for osteoarthritis.
This disease proceeds in different ways, depending on the severity, age, physical activity, and other predispositions, but today the most common symptoms are:
- pain in the knee joint, which intensifies during activity, and decreases during rest. It is caused by the nerve endings’ opening of the subchondral bone of the damaged cartilage.
- swollen knees;
- warm sensation in the joint;
- stiffness in the knee, especially in the morning or after a long time of immobility, for example, after sitting in the office or in front of the TV;
- reducing the motion of the knee joint, which makes it difficult, for example, getting out of a chair or getting out of a car. It is difficult to climb and descend the stairs, and later even walk;
- creak, crunch and cracking of the knee, especially as a result of a sudden movement of the knee joint.
Many people also say that weather changes affect the degree of pain and the functioning of the joint.
Conservative treatment (non-surgical)
- Weight loss. Losing even a few pounds can significantly reduce knee pain.
- Exercises. Strengthening and stretching the muscles around the knee gives greater stability, proper biomechanics and reduces pain.
- Analgesics and anti-inflammatory drugs. There are many drugs both prescription and over-the-counter. They help reduce pain and inflammation. But keep in mind: you cannot use painkillers for more than 10 days without consulting a doctor. Taking them longer will increase your chance of side effects.
- Injections of corticosteroids, a steroidal block of the knee. Steroids are potent anti-inflammatory drugs that eliminate pain. Unfortunately, they have very negative systemic and local effects. Thus, this form of therapy should be reserved only for patients who have been prescribed a knee replacement surgery for a short time.
- Ultrasound Intervention. Injecting knee area under ultrasound guidance. It is a very effective form of therapy, however, requiring high qualifications and experience from an orthopedic surgeon.
- Injections of hyaluronic acid, the so-called vascular complementation. Hyaluronic acid is injected into the knee joint and increases the viscosity of the synovial fluid, and therefore its lubricating properties. It reduces friction between cartilage surfaces, knee pain, cracking, and stiffness. It is often improving the range of motion.
- Tablets containing glucosamine, collagen, chondroitin. Studies have not proven their effectiveness, although they are very common.
- Anti-inflammatory ointments. They are applied externally and may bring temporary relief. Their effect, however, is significantly limited by weak penetration into the joint through the barrier of the skin, subcutaneous tissue, fascia, etc. Due to the liposomal structure, the best penetration of the drug is provided by sprays.
- Stabilizers and orthoses of the knee joint. They are indicated mainly for damage to the anterior cruciate ligament or other ligaments. They help maintain better stability of the knee joint, preventing further damage to the cartilage and meniscus.
- Physiotherapy. Often, strengthening and stretching exercises are simply necessary. Massage, manual therapy performed by an experienced physiotherapist are the most important. Physical therapy (for example, cryotherapy, ultrasound, iontophoresis) are used as additional means. Acupuncture can also have an effect. A physiotherapist will teach you ways to strengthen muscle and joint flexibility at home. He should also indicate how to perform basic exercises daily without straining the knees. Thanks to the multidirectional individually optimized approach to each patient, good results will be achieved.
- Arthroscopy is a minimally invasive endoscopic procedure. It provides safe restoration of most intraarticular structures. In two small (several mm) skin incisions in the front of the knee, a longitudinal chamber and instruments are inserted into the knee. This procedure is often performed in athletes.
- Osteotomy is a procedure for “cutting” a bone, correcting the axis of a limb, and fusion of bones. An osteotomy is often recommended for a knee fracture if it has not been properly treated. The success of such an operation largely depends on the correct classification of the patient and the proper conduct of the procedure itself.
- Prosthetics of the knee joint is a major surgical operation in which we cut the ends of the articular bones in an appropriate manner, then place the metal parts of the prosthesis on them. One part of the knee (medial) or the entire knee joint can be replaced. The purpose of the operation is to restore mobility and eliminate pain. This happens in most cases. However, it is a large and burdensome operation for which the patient must be well prepared. Complications, although rare, can be very severe (including bone infections, loosening of the endoprosthesis, thromboembolic complications). Therefore, knee replacement should be reserved for people over 55 years of age with severe osteoarthritis, in whom the correct and intensive conservative treatment did not give the expected results.